MEDICARE: GLOBAL IMAGING AND DIAGNOSTICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory	HCC9146	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HCC9146	OTHER	FL	AHCA CLINIC LICENSE

General Provider Information

NPI Number	:	1639535727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL IMAGING AND DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	12493 BRANTLEY COMMONS CT
Second Line	:	UNIT #3
City	:	FORT MYERS
State	:	FL
Zip	:	33907-5693
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12493 BRANTLEY COMMONS CT
Second Line	:	UNIT #3
City	:	FORT MYERS
State	:	FL
Zip	:	33907-5693
Country	:	US
Telephone Number	:	239-800-9485
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHAIM J MARGOLIN
Credential	:	MD
Telephone Number	:	239-565-9266

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	12/26/2016

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